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Other tumors of bone
Giant cell tumor

Author: Nat Pernick, M.D. (see Authors page)

Revised: 19 October 2016, last major update June 2005

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed search: giant cell tumor [title] bone

Related topics: benign metastasizing giant cell tumor, malignant giant cell tumor

Table of Contents
Definition / general | Radiology description | Radiology images | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology images | Positive stains | Electron microscopy description | Differential diagnosis | Additional references
Cite this page: Giant cell tumor. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonegiantcelltumor.html. Accessed July 14th, 2017.
Definition / general
  • Also called osteoclastoma
  • Benign but locally aggressive neoplasm with large numbers of osteoclast-like giant cells in background of epithelioid to spindle shaped mononuclear cells
  • Ages 20 - 40 years; 55% women, more common in Oriental countries
  • Associated with Paget disease of bone
  • Giant cells appear to be due to fusion of circulating monocytes; stromal cells appear to be neoplastic and may originate from mesenchymal stem cells that reside in bone marrow (Hum Pathol 2003;34:983)
  • Question diagnosis if tumor is in a child, lesion is in metaphysis or diaphysis of long bone, multiple lesions (unless patient has Goltz syndrome), lesion in nonsacral vertebrae, jaw of non Paget patient or hands / feet
  • Sites: knee is common site (distal femur, proximal tibia), distal radius, sacrum but can affect any bone, usually at epiphysis, may spread into metaphysis; uncommon in hand / feet, jaw, vertebrae other than sacrum
Radiology description
  • Lytic, expansile lesion of epiphysis extending to articular cartilage, usually without peripheral bone sclerosis, periosteal reaction or mineralization within the lesion
  • Within soft tissues usually produces eggshell ossification at periphery
Radiology images
Images hosted on PathOut server:

Distal femur MRI - contributed by Dr. Mark R. Wick

Proximal tibia xray - contributed by Dr. Mark R. Wick

 

Radius xray - contributed by Dr. Mark R. Wick

Tibial giant cell tumor

Chest radiograph



Images hosted on other servers:

Destructive sacral lesion with rim of reactive bone

Case reports
Treatment
  • Surgical curettage (34% recur) or en bloc excision (7% recur); may implant into adjacent soft tissue; radiation therapy only if surgical excision impossible since it may promote malignant transformation
  • Course: low grade malignancy; metastasis to lung or lymph nodes (1 - 2%) associated with cortex interruption; have similar benign microscopic appearance; good prognosis if remove metastasis; may die of tumor if diffuse metastases
Gross description
  • Large, peripheral expansile lesion, well circumscribed, hemorrhagic / red brown, cystic with necrosis
  • Thinned cortex
  • May appear fleshy white or pink or yellow in areas of foam cells
Gross images
Images hosted on PathOut server:

Contributed by Dr. Mark R. Wick

Distal femur - contributed by Dr. Mark R. Wick

Proximal femur - contributed by Dr. Mark R. Wick

 

Distal femur

Microscopic (histologic) description
  • Regular and uniform distribution of stromal cells and giant cells
  • Stromal cells are mononuclear, resemble macrophages
  • Giant cells are large, multinucleated (10 - 50 nuclei) with similar nuclei as stromal cells, resemble osteoclasts
  • Necrosis, hemorrhage, hemosiderin, reactive bone
  • Mitotic figures (not atypical)
  • 1 / 3 have focal deposition of osteoid or bone
  • May have aneurysmal bone cyst component, foam cells with spindling of mononuclear cells
  • No chondroid differentiation, no atypia
Microscopic (histologic) images
Images hosted on PathOut server:

Low power

Multinucleated giant cell

Advancing metaphyseal margin

Osseous giant cell tumor

 

Pulmonary metastasis


   

Contributed by Dr. Mark R. Wick



Images hosted on other servers:

 

Giant cells in background of spindled mononuclear cells

Anaplastic-like changes

H&E, HAM56+, MiTF+, TRAP+

Classic features

Quiz case


Multinucleated giant cells and mononuclear cells

Comparison with giant cells in other disorders

Ki67 staining in mononuclear cells

Cyclin D1 nuclear staining of giant cells

Cytology images
Images hosted on other servers:

Multinucleated giant cells and hemorrhage

Electron microscopy description
  • Giant cells have ruffled border and abundant mitochondria (resemble osteoclasts)
  • Viral-like and other intranuclear inclusions, some similar to Pagets disease of bone
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